Physicians' perspectives and attitudes toward surgical bailout in transcatheter aortic valve replacement

Commentary: Evaluating the pieces of the puzzle in building a high-quality transcatheter aortic valve replacement team

“…In this issue of the Journal , Robbins and colleagues 2 report their exploratory analysis of semistructured interviews of the TAVR team (cardiothoracic surgeons, cardiac interventionalists, and cardiac anesthesiologists) in attempt to understand physician perspectives and attitudes toward TAVR and to better understand how to best involve the patient in this decision. Although this study is limited by the number of participants interviewed (n = 13) and did not include other members of the clinical team, such as technicians and nurses, the authors' analysis revealed 4 themes: (1) clinical judgment and expertise in determining viability of surgical bailout option; (2), TAVR team dynamics; (3), emotional impact on the TAVR team; and (4) importance of patient autonomy.…”

“…Robbins and colleagues 2 highlighted the importance of shared decision-making, an evidence-based approach to decision-making where there is communication with the patient and surrogate decision makers and the clinicians. 3 Rather than communicate in a manner that is paternalistic or neutral (providing no expert opinion), this shared decision-making model, where genuine communication between the clinician and the patient is made, has been shown to improve patient outcomes, decisional conflicts, and satisfaction.…”

“…In this study, Robbins and colleagues 2 also sought to understand the perspectives and attitudes of the TAVR team (cardiac surgeons, cardiac interventionalists, and cardiac anesthesiologists). This is commendable because they embraced the key concept that cultivating collaborative cultures within a team leads to psychological safety of teams, especially when teams are diverse, as they often are in interdisciplinary teams.…”